Annals of Surgical Oncology

, Volume 21, Supplement 3, pp 385–389 | Cite as

Accuracy of CT Staging of Locally Advanced Gastric Cancer after Neoadjuvant Chemotherapy: Cohort Evaluation within a Randomized Phase II Study

  • Takaki Yoshikawa
  • Kazuaki Tanabe
  • Kazuhiro Nishikawa
  • Yuichi Ito
  • Takanori Matsui
  • Yutaka Kimura
  • Shinichi Hasegawa
  • Toru Aoyama
  • Tsutomu Hayashi
  • Satoshi Morita
  • Yumi Miyashita
  • Akira Tsuburaya
  • Junichi Sakamoto
Gastrointestinal Oncology

Abstract

Background

Accuracy of the radiologic diagnosis of gastric cancer staging after neoadjuvant chemotherapy remains unclear.

Methods

Patients enrolled in the COMPASS trial, a randomized phase II study comparing two and four courses of S-1 plus cisplatin and paclitaxel and cisplatin followed by gastrectomy, were examined. The radiologic stage was determined by using thin-slice computed tomography (CT) or multidetector low CT by following Habermann’s method.

Results

A total of 75 patients registered in the COMPASS study who underwent surgical resection were examined in this study. The radiologic T and pathologic T stages were not significantly correlated (p = 0.221). The radiologic accuracy and rates of underdiagnosis and overdiagnosis were 42.7, 10.7, and 46.7%, respectively. When patients were stratified according to the pathologic response of the primary tumor, the correlation was not significant in either the responders (n = 32, p = 0.410) or the nonresponders (n = 43, p = 0.742). The radiologic accuracy was 37.5% in the responders and 42.7% in the nonresponders. The radiologic N and pathologic N stages were significantly correlated (p = 0.000). The radiologic accuracy and rates of underdiagnosis and overdiagnosis were 44, 29.3, and 26.7%, respectively. When stratifying the patients with measurable lymph nodes according only to the radiologic response, the correlation was significant in the nonresponders (n = 23, p = 0.035) but not in the responders (n = 28, p = 0.634). The radiologic accuracy was 39.3% in the responders and 52.1% in the nonresponders.

Conclusions

Restaging using CT after neoadjuvant chemotherapy for gastric cancer is considered to be inaccurate and unreliable. In particular, the radiologic T-staging determined after neoadjuvant chemotherapy should not be considered in clinical decision-making.

Keywords

Gastric Cancer Paclitaxel Pathologic Response Peritoneal Metastasis Radiologic Response 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This work was supported by the Epidemiological & Clinical Research Information Network (ECRIN).

References

  1. 1.
    Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–917.PubMedCrossRefGoogle Scholar
  2. 2.
    Yoshikawa T, Rino Y, Yukawa N, Oshima T, Tsuburaya A, Masuda M. Neoadjuvant chemotherapy for gastric cancer in Japan: a standing position by comparing with adjuvant chemotherapy. Surg Today. 2014;44:11–21.PubMedCrossRefGoogle Scholar
  3. 3.
    Yoshikawa T, Sasako M. Gastrointestinal cancer: adjuvant chemotherapy after D2 gastrectomy for gastric cancer. Nat Rev Clin Oncol. 2012;9:192–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357:1810–20.PubMedCrossRefGoogle Scholar
  5. 5.
    Sasako M, Sakuramoto S, Katai H, et al. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol. 2011;29:4387–93.PubMedCrossRefGoogle Scholar
  6. 6.
    Bang YJ, Kim YW, Yang HK, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet. 2012;379(9813):315–21.PubMedCrossRefGoogle Scholar
  7. 7.
    National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Gastric Cancer Version 2.2011. http://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf. Accessed 25 Apr 2013.
  8. 8.
    Allum WH, Blazeby JM, Griffin SM, Cunningham D, Jankowski JA, Wong R. Guidelines for the management of oesophageal and gastric cancer. Gut. 2011;60:1449–72.PubMedCrossRefGoogle Scholar
  9. 9.
    Kwee RM, Kwee TC. Imaging in local staging of gastric cancer: a systematic review. J Clin Oncol. 2007;25:2107–16.PubMedCrossRefGoogle Scholar
  10. 10.
    Kwee RM, Kwee TC. Imaging in assessing lymph node status in gastric cancer. Gastric Cancer. 2009;12:6–22.PubMedCrossRefGoogle Scholar
  11. 11.
    Ajani JA, Mansfield PF, Lynch PM, et al. Enhanced staging and all chemotherapy preoperatively in patients with potentially resectable gastric carcinoma. J Clin Oncol. 1999;17:2403–11.PubMedGoogle Scholar
  12. 12.
    Kelsen D, Karpeh M, Schwartz G, et al. Neoadjuvant therapy of high-risk gastric cancer: a phase II trial of preoperative FAMTX and postoperative intraperitoneal fluorouracil-cisplatin plus intravenous fluorouracil. J Clin Oncol. 1996;14:1818–28.PubMedGoogle Scholar
  13. 13.
    Park SR, Lee JS, Kim CG, et al. Endoscopic ultrasound and computed tomography in restaging and predicting prognosis after neoadjuvant chemotherapy in patients with locally advanced gastric cancer. Cancer. 2008;112:2368–76.PubMedCrossRefGoogle Scholar
  14. 14.
    Yoshikawa T, Tsuburaya A, Morita S, et al. A comparison of multimodality treatment: two or four courses of paclitaxel plus cisplatin or S-1 plus cisplatin followed by surgery for locally advanced gastric cancer, a randomized phase II trial (COMPASS). Jpn J Clin Oncol. 2010;40:369–72.PubMedCrossRefGoogle Scholar
  15. 15.
    Koizumi W, Narahara H, Hara T, et al. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol. 2008;9:215–21.PubMedCrossRefGoogle Scholar
  16. 16.
    Tsuburaya A, Nagata N, Cho H, et al. Phase II trial of paclitaxel and cisplatin as neoadjuvant chemotherapy for locally advanced gastric cancer. Cancer Chemother Pharmacol. 2013;71:1309–14.PubMedCrossRefGoogle Scholar
  17. 17.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.CrossRefGoogle Scholar
  18. 18.
    Habermann CR, Weiss F, Riecken R, et al. Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US. Radiology. 2004;230:465–71.PubMedCrossRefGoogle Scholar
  19. 19.
    Hasegawa S, Yoshikawa T, Shirai J, et al. A prospective validation study to diagnose serosal invasion and nodal metastases of gastric cancer by multidetector-row CT. Ann Surg Oncol. 2013;20:2016–22.PubMedCrossRefGoogle Scholar
  20. 20.
    Sobin LH, Compton CC. TNM seventh edition: what’s new, what’s changed: communication from the International Union Against Cancer and the American Joint Committee on Cancer. Cancer. 2010;116:5336–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Sobin LH, Gospodarowicz MK, Witterkind CH. International Union against Cancer (UICC) TNM classification of malignant tumors. 7th ed. Oxford, UK: Wiley-Blackwell; 2009.Google Scholar
  22. 22.
    Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.PubMedCrossRefGoogle Scholar
  23. 23.
    Yonemura Y, Kinoshita K, Fujimura T, et al. Correlation of the histological effects and survival after neoadjuvant chemotherapy on gastric cancer patients. Hepatogastroenterology. 1996;43:1260–72.PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Takaki Yoshikawa
    • 1
  • Kazuaki Tanabe
    • 2
  • Kazuhiro Nishikawa
    • 3
  • Yuichi Ito
    • 4
  • Takanori Matsui
    • 5
  • Yutaka Kimura
    • 6
  • Shinichi Hasegawa
    • 1
  • Toru Aoyama
    • 1
  • Tsutomu Hayashi
    • 1
  • Satoshi Morita
    • 7
  • Yumi Miyashita
    • 8
  • Akira Tsuburaya
    • 9
  • Junichi Sakamoto
    • 10
  1. 1.Department of Gastrointestinal SurgeryKanagawa Cancer CenterYokohamaJapan
  2. 2.Department of Gastrointestinal SurgeryHiroshima UniversityHiroshimaJapan
  3. 3.Department of SurgeryOsaka General Medical CenterOsakaJapan
  4. 4.Department of Gastroenterological SurgeryAichi Cancer CenterNagoyaJapan
  5. 5.Department of SurgeryAichi Cancer Center, Aichi HospitalOkazakiJapan
  6. 6.Department of SurgeryNTT West Osaka HospitalOsakaJapan
  7. 7.Department of Biostatistics and EpidemiologyYokohama City University Medical CenterYokohamaJapan
  8. 8.Data Center, Nonprofit Organization ECRINOkazakiJapan
  9. 9.Clinical Research CenterShonan Kamakura General HospitalKamakuraJapan
  10. 10.Tokai Central HospitalKakamigaharaJapan

Personalised recommendations